Fetoscopic Open Neural Tube Defect Repair: Development and Refinement of a Two-Port, Carbon Dioxide Insufflation Technique

OBJECTIVE:To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patientsthe first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS:This was a retrospective cohort study (2014–2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. RESULTS:Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9–25.9] compared with 24.8 [24–25.6] weeks) were similar, but delivery occurred at 35.9 (26–39) weeks of gestation with the iterative technique compared with 39 (35.9–40) weeks of gestation with the standardized technique (P